Characterization of risk factors for vascular dementia: The Honolulu-Asia Aging Study

Department of Veterans Affairs, Honolulu, HI 96850, USA.
Neurology (Impact Factor: 8.29). 08/1999; 53(2):337-43. DOI: 10.1212/WNL.53.2.337
Source: PubMed


The Honolulu Heart Program (HHP) is a prospective study of heart disease and stroke that has accumulated risk factor data on a cohort of 8,006 Japanese American men since the study began in 1965. A recent examination of the cohort identified all patients with vascular dementia (VaD) using the criteria of the California Alzheimer's Disease Diagnostic and Treatment Center.
To characterize patients with VaD by stroke subtype and to investigate risk factors for VaD in a cohort of Japanese American men, aged 71 to 93, living in Hawaii and participating in the HHP.
Sixty-eight men with VaD were compared with 3,335 men without dementia or stroke (NSND). Men with VaD were also compared with 106 men with stroke who were not demented (SND). Candidate risk factors were measured prospectively.
Of the 68 men with VaD there were 34 (50%) whose VaD was attributed to small vessel infarcts, 16 (23%) whose VaD was related to large vessel infarcts, and 11 (16%) with both large and small vessel infarcts. The remainder could not be classified. In a multivariate logistic regression model for VaD compared with NSND containing variables found to be associated with VaD in a univariate analysis, age (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.13 to 1.27), coronary heart disease (OR 2.50, 95% CI 1.35 to 4.62), and 1-hour postprandial glucose (OR 1.41, 95% CI 1.06 to 1.88) remained significantly predictive of VaD, whereas preference for a Western diet (OR 0.54, 95% CI 0.30 to 0.98) as opposed to an Oriental or mixed diet and use of supplementary vitamin E (OR 0.32, 95% CI 0.12 to 0.82) were protective. A similar model for the comparison of men with VaD and SND revealed age (OR 1.24, 95% CI 1.14 to 1.35) was predictive of VaD, whereas preference for a Western diet (OR 0.43, 95% CI 0.22 to 0.86) was protective.
The most common stroke subtype associated with VaD was lacunar stroke. Age and traditional vascular risk factors are important contributors to the development of VaD in late life. The antioxidant vitamin E and presently unknown factors related to a Western diet as opposed to an Oriental diet may be protective against developing VaD.

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    • "A full clinical history was taken, and a meticulous examination was performed for each patient in a specialized sheet prepared specifically for this study. A psychometric assessment was also made, using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria to confirm the diagnosis and differentiate different types of dementia; Cognitive Abilities Screening Instruments (which is more comprehensive than most screening tests of cognitive abilities), which has a cutoff point of 67 or fewer points for dementia;9 the Instrumental Activities of Daily Living Scale, which provides a measure of social and occupational functioning that is used as a threshold for accepting a cognitively impaired subject as being demented;10 the Geriatric Depression Scale for diagnosis of comorbid depression;11 and the Hachinski Ischaemic Score to differentiate vascular dementia from other types of dementia (a score of 7 or higher indicates vascular dementia, a score of 5 or 6 indicates mixed dementia, and a score lower than 5 indicates AD).12 Staging of dementia was done according to the results of MMSE. We calculate a score of 17–21 for mild, 9–16 for moderate, and less than 9 for a severe degree of dementia. "
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    ABSTRACT: Dementia is one of the most important public health problems as a result of the rapid increase in the number of elderly persons worldwide. Improvement of prevention strategies and caring for people with dementia should be undertaken. We performed a door-to-door study to screen all subjects aged 50 years and older (n=4,329 of 33,285 inhabitants) in Al-Quseir city. The screening was performed by 3 neuropsychiatrists, using a modified form of the Mini-Mental State Examination. Suspected cases were subjected to case ascertainment according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnostic criteria for dementia; full clinical assessment; psychometric assessment using Cognitive Abilities Screening Instruments, Hachinski Ischaemic Score, Instrumental Activities of Daily Living Scale and the Geriatric Depression Scale; neuroimaging (computed tomography and/or magnetic resonance imaging); and laboratory investigations for selected patients when indicated. The prevalence of dementia was 2.01% for participants aged 50 years or older and 3.83% for those aged 60 years or older. It increased steeply with increasing age to a maximum of 13.5% for those aged 80 years or older. Alzheimer's dementia (48.3%) was the most common subtype, followed by vascular dementia (36.8%), dementia resulting from general medical conditions (11.5%), and last, dementia resulting from multiple etiologies (3.4%).
    Clinical Interventions in Aging 01/2014; 9:9-14. DOI:10.2147/CIA.S48325 · 2.08 Impact Factor
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    • "The term “Binswagner's disease” is used when such demyelination is widespread. The syndromes consist of loss of memory, judgment, reasoning, and changes in mood, behavior and communication abilities 3. The proportion of vascular dementia (VaD) attributed to SIVD ranges from 36 to 50%, with higher rates in African Americans and Asian Americans 4 than whites 5,6. "
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    ABSTRACT: The present study was designed to detect the abnormalities of the cerebral grey-matter density in subcortical ischemic vascular dementia patients by FSL-VBM method to promote the early diagnosis of it. Nine subcortical ischemic vascular dementia patients and nine age-matched normal controls underwent MRI brain structure scanning that was performed on a SIEMENS AVANTO 1.5 Tesla scanner and standard T1-weighted high-resolution anatomic scans of MPRAGE sequence were obtained. The 3-demensional MPRAGE images were processed with FSL-VBM package and the cerebral gray matter density was compared between the subcortical ischemic vascular dementia patients and normal controls. Compared with the normal control group, the cerebral gray matter density of subcortical ischemic vascular dementia patients was found significantly decreasing, including brain regions of thalamus, parietal lobe, frontal lobe and temporal lobe (P<0.05). The cerebral gray matter density alterations have closed correlation with cognitive dysfunction in subcortical ischemic vascular dementia patient and can be detected by MRI. MRI has some potential value in the diagnosis of them.
    International journal of medical sciences 08/2011; 8(6):482-6. · 2.00 Impact Factor
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    • "In all studies but one (Nilsson et al., 2007), the OR was significantly in favour of the hypothesis, with a higher risk of VaD in those patients who had a history of hypertension. In one of these studies, the association between hypertension and VaD is only significant when the authors removed the effect of coronary heart disease from the analysis model, suggesting that the effect was masked by coronary disease (Ross et al., 1999). However, one group reported that in subjects 80 years and older, higher systolic blood pressure was associated with good cognitive function whereas lower systolic blood pressure was associated with cognitive decline and dementia (Nilsson et al., 2007). "
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    ABSTRACT: Objective The aim of the study was to conduct a meta-analysis of epidemiological and case control studies to determine whether arterial hypertension is specifically associated with an increased risk of vascular dementia (VaD).DesignLongitudinal and cross-sectional prospective studies using operationalised criteria to define VaD and hypertension, with a normal control comparison group were systematically reviewed. Cochrane Library, Embase, Medline, and PsycInfo data sources were searched along with reference lists of included articles and reviews. Original, prevalence or incidence studies were included if operationalised criteria for hypertension and VaD as well as number of cases with and without hypertension in VaD and non-demented groups were provided. Intervention studies and post-stroke and CADASIL studies were excluded.ResultsEleven studies recruiting either volunteers or clinical patients, or which were population-based, examined a total of 768 people with VaD and 9857 control cases. A meta-analysis of the six longitudinal studies showed that hypertension was significantly associated with increased risk of incident VaD (odds ratio, OR: 1.59, CI: 1.29–1.95, p < 0.0001). A similar association between hypertension and the risk of prevalent VaD was found in the five cross-sectional studies (OR: 4.84, CI: 3.52–6.67, p < 0.00001).Conclusions Hypertension significantly increases the risk of vascular dementia. The current meta-analysis highlights the potential importance of rigorous treatment of hypertension as a key measure to help prevent the development of VaD. Copyright © 2010 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 07/2011; 26(7):661 - 669. DOI:10.1002/gps.2572 · 2.87 Impact Factor
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